By David H. Cloud; Brie Williams; Regine Haardörfer, et al

Question What is the association between exposures to extreme heat and suicide-watch incidents in a state prison system without air-conditioned living units?

Findings This case series of 6576 facility-incarceration days found that extreme heat was significantly associated with a 30% increase in the incident rate of daily suicide-watch incidents.

Meaning These findings suggest that extreme heat may increase vulnerabilities to situations that lead to suicide-watch placements for incarcerated people, bolstering calls for heat mitigation and decarceral interventions to assuage heat-induced harms among incarcerated populations.

Importance Extreme heat poses a distinct risk to the 2.1 million incarcerated people in the United States, who have disparately high rates of behavioral health conditions. Suicide is a leading cause of death among people in prisons.

Objective To examine associations of extreme heat, solitary confinement, and an indicator of suicidal behaviors among incarcerated men in a Deep South US prison system.

Design, Setting, and Participants This longitudinal case series panel study included adult men in prisons in Louisiana, a state with one of the largest prison systems in the United States that has been engaged in litigation due to lack of air conditioning and extreme heat. The unit of analysis was prison facility-days. A facility-level data set was created by merging administrative data files, which included demographic characteristics, health classification, housing location and movement, disciplinary records, and involvement in suicide-watch incidents for all incarcerated men in Louisiana during the observation period. Individual-level variables were aggregated to facility-days to merge in daily maximum heat index data from the US Local Climatological Data, which were linked to the zip codes of prisons. The observation period was January 1, 2015, to December 31, 2017. Data set construction occurred from August 2020 to September 2022, and analysis was conducted from December 2022 to February 2023.

Exposure The focal exposure was extreme heat days. Daily maximum heat index data were categorized into 6 bins (<30 °F, 30-39 °F, 40-49 °F, 50-59 °F, 70-79 °F, and ≥80 °F) and as an indicator for any facility-day where the maximum heat index exceeded the 90th percentile of heat indices for total days in observation period. Conditional fixed-effects negative binomial regression models were used to calculate incident rate ratios to test associations between extreme heat and suicide watch incidents, while controlling for covariates.

Main Outcomes and Measures The focal outcome was daily count of suicide watch incidents that were recorded in a carceral system database. Covariates included daily percentages of incarcerated persons at each prison with serious mental illness diagnosis, daily rate of solitary confinement, and total facility population.

Results The sample of 6 state-operated prisons provided 6576 facility-days for the analysis. Results suggest a dose-responsive association between extreme heat and daily counts of suicide-watch incidents; compared with days with temperatures between 60 and 69 °F, the rate of daily suicide incidents increased by 29% when the heat index reached the level of caution (ie, 80-89 °F) and by 36% when reaching extreme caution (90-103 °F) (80-89 °F: incidence rate ratio [IRR], 1.29; 95% CI, 1.17-1.43; P < .001; 90-103 °F: IRR, 1.36; 95% CI, 1.15-1.61; P  95% CI, 1.18-1.45; P < .001).

Conclusions and Relevance Findings suggest an association between extreme heat and an indicator of suicidality among an incarcerated sample, contribute to an emerging literature exploring linkages between climatological events and health outcomes in prisons, and may have implications for legal interventions and advocacy seeking to abate heat-induced morbidity and mortality in carceral contexts.

JAMA Netw Open. 2023 Aug; 6(8): e2328380.

By Christine Tartaro and David Lester

Police and corrections personnel must always be mindful of the possibility that those in their custody may attempt suicide or commit an act of self-mutilation. Persons housed in prisons, jails, and police lockups tend to be at a higher risk for such destructive behavior than members of the general population. Reasons for this can be found by examining the mental health, substance abuse, and physical/sexual abuse histories of inmates in addition to deficits in their coping skills and the stress and uncertainty generated by incarceration.

This book explores several topics pertaining to suicide and deliberate self-harm in the corrections setting, including who tends to commit these acts; where, when, and how these incidents occur; screening mechanisms; the role of environmental stimuli in facilitating or preventing acts of self harm; interpersonal relations among inmates and between inmates and staff; and the role of the courts in setting and ruling on suicide prevention policies. The authors discuss the role of prevention techniques that offer a balance between strict opportunity-reduction and softer motivation-reduction strategies. The book also includes suggestions for diversion programs that can keep mentally ill inmates out of prisons and jails and transition planning programs to better prepare outgoing inmates for their re-entry into the community.

Lanham, MD: Lexington Books, 2009. 238p.

By Graham J Towl , David A Crighton , Toby Harris

The definitive guide from two leading authors central to developments in the field. An invaluable book which covers everything from theoretical and community research to precisely what is known about prisoners and the risk of their committing suicide. Covers the Harris Review and Government Response to it as well as the stance of politicians, reform groups and other leading experts on what in 2017 is an escalating problem for UK prisons. Contains analysis and data from over 30 years, bringing together key knowledge and information at a critical time of concern and attention.

Sherfield on Loddon,: Waterside Press , 2017. 208p.

By Alison Liebling

The suicide rate in prisons in England and Wales is 40 per 100,000—four times that of the general population. How can this rate be explained? Recent prison suicides have aroused much public concern and media attention, yet there has been very little research examining their true cause or nature. Previous studies have tended to rely exclusively on official statistics and prison records, and have had little effect on formulating policy and practice. Suicides in Prison is the first major study in this area to draw directly on the experiences of both prisoners and staff. The interviews conducted by the author help to cast new light on the circumstances which can lead to suicide or attempted suicide. The book provides further evidence to support the growing recognition that suicide is not an exclusively psychiatric problem. The coping mechanisms and social support given to the people involved can play a crucial role. Alison Liebling also shows how serious difficulties in the management of prisoners at risk of suicide may be exacerbated by problems of communication between departments, and that prison officers may lack the necessary training to play a potentially major role in suicide prevention. Most importantly, if staff perceptions and attitudes are not addressed, any attempt to improve procedures may well be ineffective. Suicides in Prison will be of interest to probation officers, social workers and prison staff and governors as well as those studying penology. It traces the recent history of the problem and provides the first major theoretical discussion of the nature and causes of suicide in prison.

London: Routledge, 1992. 288p.

By Lindsay M. Hayes

While suicide is recognized as a critical problem within the jail environment, the issue of prison suicide has not received comparable attention. Until recently, it has been assumed that suicide, although a problem for jail inmates as they face the initial crisis of incarceration, is not a significant problem for inmates who advance to prison to serve out their sentences. This assumption, however, has not been supported in the literature. Although the rate of suicide in prisons is far lower than in jails, it remains disproportionately higher than in the general population.

Windsor Mill, MD: National Center on Institutions and Alternatives, Washington, DC: U.S. National Institute of Corrections, 1995. 116p.

By Graham J Towl and David A Crighton

The definitive guide from two leading authors central to developments in the field. An invaluable book which covers everything from theoretical and community research to precisely what is known about prisoners and the risk of their committing suicide. Covers the Harris Review and Government Response to it as well as the stance of politicians, reform groups and other leading experts on what in 2017 is an escalating problem for UK prisons. Contains analysis and data from over 30 years, bringing together key knowledge and information at a critical time of concern and attention.

Hook, UK: Waterside Press, 2017. 208p.

By Alison Liebling

The suicide rate in prisons in England and Wales is 40 per 100,000—four times that of the general population. How can this rate be explained? Recent prison suicides have aroused much public concern and media attention, yet there has been very little research examining their true cause or nature. Previous studies have tended to rely exclusively on official statistics and prison records, and have had little effect on formulating policy and practice. Suicides in Prison is the first major study in this area to draw directly on the experiences of both prisoners and staff. The interviews conducted by the author help to cast new light on the circumstances which can lead to suicide or attempted suicide. The book provides further evidence to support the growing recognition that suicide is not an exclusively psychiatric problem. The coping mechanisms and social support given to the people involved can play a crucial role. Alison Liebling also shows how serious difficulties in the management of prisoners at risk of suicide may be exacerbated by problems of communication between departments, and that prison officers may lack the necessary training to play a potentially major role in suicide prevention. Most importantly, if staff perceptions and attitudes are not addressed, any attempt to improve procedures may well be ineffective. Suicides in Prison will be of interest to probation officers, social workers and prison staff and governors as well as those studying penology. It traces the recent history of the problem and provides the first major theoretical discussion of the nature and causes of suicide in prison.

London; New York: Routledge, 1998. 288p.